Across the country, Americans have placed health care at the summit of their financial fears — above rent, groceries, and the electric bill — a shift made concrete by the expiration of pandemic-era federal subsidies that once made insurance affordable for millions. A KFF survey of 1,426 adults, conducted in January 2026, finds two-thirds of respondents more anxious about medical costs than any other household expense, a sentiment sharpened by premium increases of 23 to 40 percent and a national enrollment decline of 5.5 percent. The moment reflects a recurring tension in American life: the dis
Health care costs top Americans' financial worries, KFF survey shows
Millions of Americans face reduced access to health insurance and increased financial hardship; 202,000-261,000 Floridians dropped ACA coverage due to premium increases.
Congress did the wrong thing by not extending the subsidies
Mark
So the headline is that health care costs are Americans' top financial worry now. But what changed? Wasn't health care always expensive?
Mimi
It was, but the subsidies made it manageable for millions of people. When those expired at the end of 2025, premiums jumped 23 to 40 percent overnight. That's not a gradual creep—that's a shock.
Luke
Right, but I want to be precise about the numbers. We know 202,000 to 261,000 Floridians dropped coverage. That's a range, not a fixed number. And the 5.5 percent national decline—is that because people couldn't afford it, or did some people find other options?
Mimi
The source doesn't break down the reasons people left. We know they left, and we know premiums went up sharply. The connection is reasonable, but you're right that the source doesn't confirm causation directly.
Mark
What strikes me is that 67 percent of Americans—across all parties—said Congress did the wrong thing. That's unusual agreement.
Mimi
It is. And it happened even though the political fight over the subsidies was bitter enough to trigger a 43-day government shutdown. People were angry about the shutdown, but they still agreed Congress should have extended the help.
Luke
I notice the survey was done in January, after the enrollment deadline closed on January 15. So people were already living with the higher premiums by the time they answered. That context matters—they weren't speculating; they were reporting on something they'd already experienced.
Mark
And 32 percent said they're "very worried" about affording health care. That's a third of Americans.
Mimi
It's the single largest financial worry in the survey. More people are very worried about health care than about any other expense—groceries, rent, utilities, gas. Nothing else comes close.
Luke
Though I'd note: the survey asked about "very worried," not just "worried." The full picture includes people who are somewhat worried but not very worried. The anxiety is even broader than that 32 percent.
Mark
So what happens next? Are people just absorbing these higher costs, or are they making other changes?
Mimi
The enrollment numbers suggest some people are dropping out entirely. But the survey doesn't tell us what happens to those 202,000 Floridians who lost coverage—whether they went uninsured, found employer coverage, or something else.
The Pulse
- The expiration of enhanced ACA subsidies at the end of 2025 triggered premium increases of 23 to 40 percent, hitting millions of Americans with sticker shock the moment their renewal notices arrived.
- Florida alone lost between 202,000 and 261,000 ACA enrollees in a single year, and nationally 5.5 percent fewer Americans carry marketplace coverage heading into 2026.
- Thirty-two percent of adults say they are 'very worried' about affording health care — a larger share than those most anxious about groceries, rent, utilities, or gas combined.
- A 43-day government shutdown — the longest in U.S. history — was partly fueled by the political fight over subsidy renewal, yet ended in November without restoring the aid.
- Sixty-seven percent of Americans, including 63 percent of Republicans, say Congress was wrong not to extend the subsidies, signaling rare cross-partisan pressure for legislative action.
- As enrollment windows close and 2026 coverage locks in, millions are now absorbing higher premiums without the federal cushion that defined the pandemic years — and Congress has yet to act.
Across the country, Americans have placed health care at the summit of their financial fears — above rent, groceries, and the electric bill — a shift made concrete by the expiration of pandemic-era federal subsidies that once made insurance affordable for millions. A KFF survey of 1,426 adults, conducted in January 2026, finds two-thirds of respondents more anxious about medical costs than any other household expense, a sentiment sharpened by premium increases of 23 to 40 percent and a national enrollment decline of 5.5 percent. The moment reflects a recurring tension in American life: the distance between the promise of accessible health care and the lived reality of its cost. Congress, which allowed the subsidies to lapse without renewal, now faces a public that — across party lines — believes it made the wrong call.
When Americans sit down to worry about money, health care now claims the top of the list. A KFF survey of 1,426 adults conducted in January found two-thirds of respondents more anxious about medical costs than about housing, food, utilities, or gas. The finding lands at a moment of real financial strain: the expiration of enhanced federal subsidies for Affordable Care Act plans has sent premiums sharply higher and pushed enrollment down across the country.
Those subsidies were emergency measures created during the COVID-19 pandemic in 2021. Congress allowed them to expire at the end of 2025 without renewal, leaving millions facing steep increases when their renewal notices arrived. The political standoff over extending the aid contributed to a 43-day government shutdown last fall — the longest in U.S. history — which ended November 12 without restoring the assistance.
The enrollment numbers reflect who bore the cost. Nationally, 23 million Americans signed up for ACA coverage in 2026, a decline of 5.5 percent from the prior year. Florida, which led the nation with 4.74 million enrollees in 2025, fell to 4.5 million — a loss of between 202,000 and 261,000 people. Premium increases were steep: finalized 2026 rates show jumps of 23 to 40 percent. Scott Darius of Florida Voices for Health called it a 'massive single year jump,' noting that Congress's failure to extend the tax credits means working Floridians absorb the full force of those increases.
The KFF survey captures how broadly the anxiety has spread. Thirty-two percent of adults say they are 'very worried' about affording health care — more than those most concerned about groceries, rent, utilities, or transportation. More than half reported their health care costs rose in the past year. And 67 percent — including 89 percent of Democrats, 72 percent of independents, and 63 percent of Republicans — said Congress did the wrong thing by letting the subsidies lapse. As 2026 coverage takes hold and enrollment windows close, millions of Americans are navigating a more expensive system without the federal help that once made it workable.
When Americans sit down to worry about money, health care now sits at the top of the list—ahead of rent, ahead of groceries, ahead of the electric bill. A survey of 1,426 adults conducted by KFF in January found that two-thirds of respondents rank their anxiety about medical costs higher than their concern for housing, food, utilities, or gas. The finding arrives at a moment of genuine financial strain, as the expiration of enhanced federal subsidies for Affordable Care Act plans has sent premiums climbing and enrollment falling across the country.
The subsidies in question were emergency measures put in place during the COVID-19 pandemic in 2021. Congress allowed them to expire at the end of 2025 without renewal, a decision that left millions of Americans facing sticker shock when their renewal notices arrived. The political fight over whether to extend the assistance contributed to a 43-day government shutdown last fall—the longest in U.S. history, ending November 12. The shutdown resolved without restoring the aid.
The numbers tell the story of who felt the impact. Nationally, 23 million Americans enrolled in ACA coverage for 2026, a decline of 5.5 percent from the previous year. KFF had projected at one point that as many as 5 million people could lose coverage entirely. Florida, which had the highest ACA enrollment of any state at 4.74 million in 2025, saw that number drop to 4.5 million this year—a loss of between 202,000 and 261,000 people, according to Centers for Medicare and Medicaid Services data from January 28. The state still leads the nation in total ACA enrollment, but the 5.5 percent decline mirrors the national trend.
Premium increases have been steep. According to Florida Voices for Health, a nonprofit advocacy organization, finalized rates for 2026 show premiums jumping between 23 and 40 percent. Scott Darius, the group's executive director, described 2026 as a "massive single year jump," noting that while rates have been climbing for years, this year's increase stands apart. "Making matters worse," he said, "Congress's decision to not extend the enhanced premium tax credits means hardworking Floridians will bear the brunt of these increases."
The KFF survey captures the breadth of financial anxiety Americans are experiencing. Eighty-two percent of respondents said their cost of living has increased in the past year, with half reporting increases they described as substantial. When asked about specific worries, 32 percent said they are "very worried" about affording health care for themselves and their families—a larger share than those most anxious about groceries (24 percent), rent or mortgage payments (23 percent), utility bills (22 percent), or transportation costs (17 percent). More than half of all respondents reported that their health care costs rose in the past year, with at least one in five saying those costs climbed faster than food or utility expenses.
The political dimension is clear in how Americans view Congress's inaction. Sixty-seven percent of survey respondents said Congress did the wrong thing by not extending the subsidies. That view crosses party lines: 89 percent of Democrats, 63 percent of Republicans, and 72 percent of independents agreed. The survey included nearly equal numbers of registered voters from each party affiliation, making the consensus striking. As enrollment deadlines have closed and 2026 coverage has begun, millions of Americans are now navigating higher premiums without the federal help that made coverage affordable during the pandemic years.
Notable Quotes
2026 is a massive single year jump in premiums, and Congress's decision to not extend the enhanced premium tax credits means hardworking Floridians will bear the brunt of these increases.— Scott Darius, executive director of Florida Voices for Health
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